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CPR Exam 2 > Pneumonia DSA > Flashcards

Pneumonia DSA Flashcards

1
Q

What mechanisms of spread can cause pneumonia?

Which is the most common?

A
  • 1. Descend from oropharynx => LRT
    • 90% of the time
    1. Inhalation of viruses
  • 3. Hemotogenously (staph)
  • 4. Direct infection
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2
Q

What is the most common cause of CAP?

A

Streptococcus pneumonia

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3
Q

What are risk factors for pneumonia?

A
  1. Alterations in anatomic barriers
  2. Damaged cell-mediated or humoral immunity.
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4
Q

What are other common bacterial pathogens for CAP?

A
  1. H. influenzae
  2. Atypical pathogens:
  • Mycoplasma pneumonia,
  • Chlamydophila pneumoniae
  • Legionella
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5
Q
  • _______: comorbidities and extended care faciliy residents
  • ________: alcoholism
  • _____: structural lung disease
  • ______: after ABX therapy
  • _____: after hospitalization
  • _______: aspiration
A
  • Gram - bacteria
  • Klebsiella
  • Pseudomonas aeruginosa
  • Pseudomonas aeruginosa
  • Pseudomonas aeruginosa
  • Enteric gram (-) and anaerobic organisms
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6
Q

What viral pathogens can cause pneumonoia

A
  • Influenza
  • Parainfluenza
  • Adenovirus
  • RSV
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7
Q

What virus can increase the chances of a NL healthy person to secondary invasive infections with pneumococcal or methicillin resistant Staph auerus pneumonia, causing Increase morbitidty and death during epidemics/pandemics?

A

Influenza

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8
Q

How can we prevent pneumonia?

A
  1. Influenza vaccine for all ppl older than 6months.
  2. Oseltamivir and zanamivir in an unvaccinated high-risk person during influenza epidemia.
  3. PPSV23 to prevent pneumococcal bacteria and meningits in healthy, immunocompetent adults (all over 65 and under 65 who live in long-term care places who have have CAD, COPD, alcohoslism, cirrhosis, etc and immunocompromised)
  4. PCV13 for all adults 65 & older and pts that are [immunocompromised, aspleic, CSF leaks, cochlear impants].
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9
Q

How are pneumococcal vaccines administered?

A
    • NEver had vaccine: PCV13 is given first; PPSV23 8 wks later
  • -If already given PPSV23; give PCV13 1 year after.
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10
Q

Pneumonia should be considered in what patients w what sxs?

A
  1. Cough
  2. Sputum
  3. Fever
  4. Chills
  5. Dyspnea
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11
Q

What is CURB-65 severity score for whether you should admit someone or discharge pt with pneumonia; what scores are necessary?

A
    • Confusion
    • BUN >20 mg/dL;
    • RR >30;
    • BP (systolic <90 or diastolic <60)
    • Age 65 y/o or older

*Each worth 1 point –> 0-1 = outpatient; 2 = moderate/severe - short hospitalization; 3-5 = severe pneumonia/ICU

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12
Q

What are 3 Abx options for Mycoplasma pneumoniae?

A
  1. Macrolides
  2. Tetracyclines
  3. Fluoroquinolones
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13
Q

How do we treat patient in OUTPATIENT setting without CP disease or other comorbidities?

A

Macrolide or doxycycline

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14
Q

How do we treat patient in OUTPATIENT setting WITH CP disease or other comorbidities?

A
  • Respiratory quinolone
    • or
  • B-lactam + macrolide/doxycycline
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15
Q

What provides coverage for atypical organisms?

A

Macrolide, quinolones and doxycline

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16
Q

For the emperic tx of commuity acquired pneumonia what is first drug you should consider using in an ambulatory patient; what if they can’t tolerate this first lin drug?

A
  • Macrolide = 1st
  • Can’t tolerate –> go with Doxycycline
17
Q

For the emperic tx of commuity acquired pneumonia what are 2 options for pt at increased risk for drug resistance (Abx in past 90 days, immunosuppression, exposure to kids)?

A
  • Fluoroquinolone
  • Macrolide + beta-lactam
18
Q

For the emperic tx of commuity acquired pneumonia what should you give to hospitalized pt?

A
  • FIRST: Supplimental O2
  • THEN: IV ABX within 6 hours of arrival
      • Respiratory quinolone
      • B-lactam + macrolide/doxycline
  • IV hydration
19
Q

What should we give for patients when aspiration is suspected

A
  1. Clindamycin
  2. B-lactam/B-lactamase inhibitor (ampicillin-sulbactam, piperacillin-tazobactam)
20
Q

What type of pneumonia patients require ICU?

A
    1. Severe pneumonia who have increased risk for death
    1. Respiratory failure who need mechanical ventilation
    1. Septic shock
21
Q
  • How long do we treat pts with mild-moderate CAP?
  • Legionella?
  • Pts with severe illness, empyema, lung abscess, meningitis, infection with P. aeruginosa/S. aeurus?
    *
A
  • 7 or less days if good clinical outcome, no fever for 48-72 hours, no extrapulm infection
  • 5-10 days if quinolone is used
  • 10 or more days
22
Q

How does treatment differ if pt has S. aeurus pneumonia vs. uncomplicated bactermic pneumococcal pneumonia?

A
  • S. aureus: 4-6 weeks of therepy and test for endocarditis
  • -7-10 days
23
Q

In hospitalized illness, when do we switch from IV ABX to ORAL?

A
  • Once sx improve
  • no fever on 2 occasions 8 hours apart
  • can take meds by mouth
24
Q

What can be given to patients to speed recovery and minimize complications of CAP?

A

1. Beta agonists via hand-held nebulizer

2. Chest physical therapy

OMM

25
Q

What is healthcare-associated pneumonia (HAP)?

A

Pneumonia the develops 48 hours after hospitalization

26
Q

HAP includes what 3 types of pneumonia?

most common?

A
  • 1. Ventilator-associated pneumonia **
    • ​MC and affects intubuated pts 48 hrs after endotracheal intubation
  • 2. Non-ventilator assx pneumonia
  • 3. Post-operative pneumonia
27
Q

MCC of HCAP?

A

Microaspiration of bacteria that colonize the oropharyx and upper airways in seriously ill patients

  1. Gram (-) baccilli
  2. S. aerus
28
Q

Greatest overal risk of HCAP?

A

Endotracheal intubation with mechanical ventilation

29
Q

What reduces risk of HCAP?

A
    1. Avoid intubation
    1. Prompt intubation, if needed.
30
Q

Other ways to prevent infection and HCAP?

A
  1. Wash hands
  2. While intubating patiens, they should be upright or semi-upright to decrease aspiration
  3. Mough care
31
Q

How can we dx VAP?

A
  1. CP
  2. leukocytosis
  3. new or changing radiographic finnings
  4. decline in oxygenation
32
Q

If person is suspected to have VAP, what is the first thing we do?

A

GIVE ABX (pick based on risk of multi-drug resistant pathogens; prolong duration of hospitalization (5 or more days) , admission from health-care related facility, recent prlonged ABX therapy)

do not delay for diagnositc testing.

33
Q

Patients with no risk factors of VAP should be treated with ______.

W/ risk factors _______

A
  • No risk factors: ceftriaxone or levofloxacin
  • Risk factors: antipseudomonal agent or vancomycin
34
Q
A

CPR Exam 2 (29 decks)

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